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Gross Anatomy Flashcards

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1
Q

Mandible

A

Largest and strongest none of face

Consists of body, rami, coronoid process (temporalis muscle), and condyle

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2
Q

Mandibular foramen

A

Located on medial side of ramus under the lingula

IA nerve, artery, and vein

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3
Q

Mental foramen

A

Located below second premolars

Mental nerve (skin and mucous membrane)

Incisive nerve (pulp chambers of anterior teeth)

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4
Q

Scalp

A 
S: skin (epidermis, dermis)
C: connective tissue (superficial fascia)
A: aponeurosis 
L: loose connective tissue 
P: periosteum

Dura mater
Arachnoid
Subarachnoid space
Cerebrum

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5
Q

What attaches to the lingula?

A

The sphenomandibular ligament

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6
Q

Epidural space

A

Potential space between periosteum and dura mater
Contains middle meningeal artery

Epidural hematoma = middle meningeal

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7
Q

Dura mater

A

Membranous outermost meninge that forms venous sinuses

Endosteal layer on periosteum side
Meningeal layer on brain side

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8
Q

Subdural space

A

Between dura and arachnoid
Contains bridging veins and venous sinuses

Subdural hematoma= bridging vein

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9
Q

Arachnoid

A

Weblike lattices between dura and pia

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10
Q

Subarachnoid space

A

Between arachnoid and pia

Filled with CSF

Contains Circle of Willis

Space entered with lumbar puncture

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11
Q

Vertical dura mater folds

A

Falx cerebri: separates left and right cerebral hemispheres; contains superiors and inferior sagittal sinuses

Falx cerebelli: separates cerebellum; contains occipital sinus

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12
Q

Horizontal dura mater folds

A

Tentorium cerebelli: separates cerebrum from cerebellum; contains straight, transverse, and superior petrosal sinuses
Uncus: medial parahippocampal gyrus

Diaphragma sella: roof of sella turcica

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13
Q

Dural sinuses

A 
Superior sagittal 
Inferior sagittal 
Straight sinus 
Cavernous sinus (2)
Superior petrosal sinus (2)
Inferior petrosal sinus (2) 
Occipital sinus 
Transverse sinus (2)
Confluence of sinuses 
Sigmoid
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14
Q

Tributaries of dural sinuses

A

Emissary veins: drain scalp to dural sinuses

Diploic veins: drain diploe of skull to dural sinuses

Meningeal veins: drain meninges into dural sinuses

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15
Q

What major vessel drains the head and neck?

A

Internal jugular vein

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16
Q

Cavernous sinuses

A

Anterior: superior and inferior ophthalmic veins, pterygoid plexus
CNs 3, 6, V1, V2

Posterior: superior and inferior petrosal, intercavernous sinus
CN 6, ICA

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17
Q

What sinus connects the cavernous and sigmoid sinuses?

A

The superior petrosal sinus

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18
Q

Which nerve is the smallest and most medial in the cavernous sinus and will be the first affected by an infection or laterally expanding pituitary tumor?

A

CN VI

CV III and IV are also in this area

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19
Q

Pterygoid plexus of veins

A

Located in infratemporal fossa

Surrounds maxillary artery

Drains maxillary vein posteriorly and deep facial vein anteriorly (connects with anterior facial vein)

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20
Q

Ventricular system of brain

A

Ependymal cells line and produce CSF

Lateral ventricle near caudate nucleus
Inferior horn near hippocampus
Third ventricle near hypothalamus
Fourth ventricle near pons

Choroid plexus and ventricular system regulate intracranial pressure

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21
Q

CSF circulation

A
  1. Lateral ventricles
  2. Foramen of Monro
  3. Third ventricle
  4. Cerebral aqueduct
  5. Fourth ventricle
  6. Foramina of Magendie (medial) and Luschka (lateral)
  7. Bathes cisterns in subarachnoid space
  8. Arachnoid granulations into superior sagittal sinus to empty CSF into venous circulation
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22
Q

Where is CSF made?

A

Choroid plexus

Ependymal cells can also make CSF

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23
Q

Blood brain barrier

A
  1. Blood CSF barrier: tight junctions in choroid plexus epithelial cells allow selective passage
  2. Vascular endothelial barrier: tight junctions between endothelial cells
  3. arachnoid barrier: arachnoid cells form a barrier to present substances from dural vessel from diffusing toward brain
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24
Q

Circle of Willis

A 
Posterior cerebral artery 
Posterior communicating artery 
Internal carotid artery 
Anterior cerebral artery 
Anterior communicating artery

2 vertebral arteries and 2 carotid arteries

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25
What arteries supply medial aspect of frontal and parietal lobes?
Right and left internal carotid arteries Branch to anterior cerebral artery and middle cerebral artery
26
What supplies occipital cortex?
Basilar artery (convergence of left and right vertebral arteries) Branches to posterior cerebral artery
27
Does the internal carotid artery have branches in the neck?
No
28
Vertebral arteries branch off of what?
Subclavian arteries
29
Middle cerebral artery
Largest branch of the ICA Causes the most ischemic injury if blocked Leticulostriate arteries, branches of MCA, are often involved in stroke and are thin walked and can rupture
30
Tongue Innervation
Motor: CN XII Damage to CN XII causes tongue to deviate to the side damaged Sensation: CN V3, IX, X Taste: CN VII, IX, X
31
Even though the anterior 2/3, posterior 2/3 of tongue and epiglottis have different Innervation (CN VII, CN IX, and CN X respectively), where do their pathways converge?
Solitary tract to nucleus of solitary tract (gustatory nucleus) Thalamic nucleus (VPM)
32
Chorda tympani nerve
Part of CN VII Solitary tract nucleus, superior salivatory nucleus Arises from geniculate ganglion, emerges from petrotympanic fissure, crosses tympanic membrane and joins lingual nerve (V3) Taste to anterior 2/3 of tongue Preganglionic parasympathetic synapse in submandibular ganglion
33
Inferior surface of tongue
Lingual frenulum: vertical fold in midline Plica fimbriata: fold of mucous membrane lateral to frenulum Wharton's and Rivian ducts: openings to submandibular and sublingual salivary glands
34
Types of tastebuds
Filiform: rough, avascular, no tastebuds, rough texture of tongue Fungiform: mushroom shaped, contain tastebuds Circumvallate: large circular structures with tastebuds Foliate: lateral surface of tongue, nonfunctional
35
Muscles controlling the tongue
Bony attachments: genial tubercles, styloid process, and hyoid bone Innervation of tongue muscles = CN XII (except palatoglossus) Blood supply = lingual artery
36
Genioglossus muscle
O: genial tubercles I: hyoid (inferior) and tongue (superior) A: protrudes tongue N: XII
37
Hyoglossus muscle
O: hyoid I: side of tongue medial to styloglossus A: depress tongue, pulls down side N: XII
38
Styloglossus muscle
O: styloid process I: side of tongue A: pulls tongue up and back N: XII
39
Palatoglossus muscle
O: anterior soft palate I: side and dorsum of tongue A: pulls tongue up and back N: X
40
Intrinsic tongue muscles
Longitudinal: shorten tongue, make dorsum convex (inferior) or concave (superior) Transversus: narrow and elongate tongue Verticalis: flattens and broadens the tongue
41
Speaking sounds: "La la" "Mi mi" "Kuh kuh"
CN XII moved tongue against roof of mouth CN VII moves lips CN X raises palate
42
Hyoglossus muscle relationships
Medial to = lingual artery Lateral to = lingual vein, nerve, submandibular duct, hypoglossal nerve
43
Palate nerve, blood supply
Motor Innervation: pharyngeal plexus Sensory Innervation: V2 (greater palatine posteriorly, nasopalatine anteriorly) Blood supply: third part of maxillary artery (branch of ECA)
44
Palatial salivary glands
Mostly mucous Located beneath mucous membrane if hard and soft palate
45
Hard palate components
Maxillary bone (palatine processes) Palatine bones (horizontal plates) Covered with keratinized mucosa Palatial salivary glands beneath mucosa
46
Soft palate components
Muscles: palatopharyngeus, palatoglossus, levator veli palatini, tensor veli palatini; uvular Covered by non-keratinized mucosa Anterior zone of sub mucosa contains fat Posterior zone contains mucous glands Palatal aponeurosis: fibrous connective tissue over muscles
47
Soft palate attachments
To the tongue: palatoglossus arches (anterior pillar) Palatoglossus draws tongue and soft palate together, narrows isthmus of fauces To the pharynx: palatopharyngeal arches (posterior pillar) Palatopharyngeus elevated pharynx, closes nasopharynx and aids in swallowing
48
Uvula
Suspended from soft palate Bifid uvula from incomplete fusion of palatine shelves Unilateral damage to pharyngeal plexus causes uvula to deviate contralaterally (pulled to functional side)
49
Fauces
Fauces are between anterior and posterior pillars House the palatine tonsils
50
Tonsils
Pharyngeal: located on nasopharynx and do not have lymph, sinuses not crypts Palatine: located in isthmus if fauces and contain crypts and lymphoid follicles, but no sinuses Lingual: located in dorsum of tongue and contain lymphoid follicles each with a single crypt
51
Waldeyer's ring
Ring of lymphoid tissue Lingual tonsil inferiorly Palatine tonsils laterally Nasopharyngeal tonsils superiorly
52
Which two muscles prevent food from entering the nasopharynx during swallowing?
Tensor and levator veli palatini
53
Tensor vs levator veli palatini
Tensor: origin on greater wing of sphenoid, insertion on hamulus and palatal aponeurosis, tenses palate and opens auditory tube, innervated by V3 Levator: origin on inferior petrous temporal bone, inserts on palatine aponeurosis, elevates and raises palate, innervated by CN X
54
What two muscles meet at the pterygomandibular raphe?
Buccinator and superior pharyngeal constructor
55
Pharyngeal muscles - constrictors
Superior, middle, inferior and cricopharyngeus Contract in waves to propel food Sensory Innervation from CN X Motor from CN XI
56
Pharyngeal muscles - longitudinal muscles
Palatopharyngeus: raises pharynx and larynx during swallowing (CN XI) Salpingopharyngeus: elevates nasopharynx and opens auditory tube to equalize pressure (CN XI) Stylopharyngeus: raises pharynx and larynx during swallowing (CN IX)
57
Which nerves comprise the pharyngeal plexus?
CN IX, X and XI Innervated constrictors, palatoglossus, Palatopharyngeus, and cricopharyngeus
58
What is the only muscle innervated by CN IX?
Stylopharyngeus
59
Three phases of swallowing
1. Oral phase: moisten, masticate (CN V), trough tongue (CN XII), voluntary movement of bolus 2. Pharyngeal phase: close nasopharynx via tensor veli palatini (CN V) and levator veli palatini (CN X), elevate pharynx and hyoid via style pharyngeus, salpingopharyngeus and Palatopharyngeus (CN IX and X); close pharynx, retroversion of epiglottis, adduction of vocal cords; bolus passes through and constrictors go though wavelike contraction 3. Esophageal phase: esophageal peristalsis (CN X) and relaxation
60
During swallowing, where can food get caught?
Vallecula or pyriform recess
61
Nasolacrimal apparatus
Lacrimal gland: produces tears Lacrimal puncta: collects tears and drains to lacrimal canals Lacrimal canals join lacrimal sac which drains down nasolacrimal duct Nasolacrimal duct empties underneath inferior nasal concha into inferior meatus
62
Lacrimal gland
Paired serous glands involved in tear production Parasympathetic Innervation via superior salivatory nucleus, greater petrosal nerve (CN VII), and lacrimal nerve (CN VI)
63
Lymphatic drainage of oral cavity
Parotid gland through parotid nodes then to superior deep cervical nodes Submandibular and sublingual through submandibular and deep cervical nodes
64
What major vessel supplies all salivary glands?
External carotid artery
65
Parotid gland
Serous secretion Stenson's (parotid) duct Pre ganglionic Innervation from lesser petrosal nerve (CN IX) synapse in otic ganglion, post ganglionic innervation with auriculotemporal nerve (V3) Superficial temporal artery and facial artery supply blood
66
Submandibular gland
Serous and mucous secretion Wharton's (submandibular) duct Empties at sublingual caruncle Pre ganglionic via chorda tympani (CN VII), synapses at submandibular ganglion, postganglionic goes to gland Blood supply from facial artery
67
Submandibular gland
Mucous secretion Sublingual (Rivian) ducts Open directly into oral cavity in sublingual fold Pre ganglionic via chorda tympani (CN VII), synapses at submandibular ganglion, postganglionic at gland Blood supply from lingual artery
68
Minor salivary glands
Labial and buccal: mucous only Von ebners glands: serous only Glands of Blandin-Nuhn: mixed serous mucous
69
Which gland emits the highest volume of salivary fluid per day?
Submandibular gland Parotid is second
70
Mastication
Process of biting and chewing food to make it soft to swallow
71
Muscles of mastication
Masseter Temporalis Medial and lateral pterygoid All innervated by CN V3 Accessory muscles: supra- and infrahyoids Tongue and buccinator are crucial for controlling bolus (CN XII and VII respectively)
72
A left subcondylar fracture will deviate the mandible to which side?
The left because only the right lateral pterygoid is functional
73
Masseter muscle
O: superficial head on zygomatic process of maxilla and zygomatic arch, deep head on inner zygomatic arch I: superficial head on angle of mandible, deep head on lateral ramus A: elevation and retrusion N: V3
74
Temporalis muscle
O: temporal fossa I: medial coronoid process A: retrusion and elevation, ipsilateral excursion N: V3
75
Medial Pterygoid muscle
O: medial side of lateral pterygoid plate I: medial mandible angle A: elevation, some contralateral excursion and protrusion N: V3
76
Lateral pterygoid muscle
O: superior head on greater wing of sphenoid, inferior head on lateral side of lateral pterygoid plate I: superior head on articular capsule and disc, inferior head on condylar neck A: protrusion, depression, contralateral excursion N: V3
77
Which muscles are involved in jaw opening?
Lateral pterygoids, suprahyoids, infrahyoids
78
Which muscles are involved in jaw closing?
Temporalis, masseter, medial pterygoids
79
Which muscles are responsible for jaw protrusion?
Pterygoid muscles
80
Which muscles are responsible for jaw retrusion?
Temporalis, masseter (deep)
81
Which muscles are responsible for jaw excursion?
Contralateral pterygoid muscles, ipsilateral masseter and temporalis
82
TMJ
Bilateral synovial joint Upper compartment = translation Lower compartment = rotation
83
TMJ components
``` Glenoid/mandibular fossa of temporal bone Articular cartilage Disc Condylar cartilage cap Condyle of mandible ``` Articular capsule surrounds joint with synovium internally
84
What type of cartilage covers articular surfaces of the TMJ?
Fibrocartilage Not hyaline as is seen in most synovial joints
85
Nerves of TMJ
Auriculotemporal nerve (V3): pain in capsule and parasympathetic Innervation to parotid gland Nerve to masseter (V3): anterior TMJ Posterior deep temporal nerve (V3): anterior TMJ
86
TMJ ligaments
Temporomandibular: oblique portion prevents posterior and inferior displacement, horizontal portion prevents lateral displacement Sphenomandibular: remnant of Meckel's cartilage that connects sphenoid with mandible lingula Stylomandibular: connects styloid to angle of mandible
87
What is the only direction the TMJ can be dislocated?
Anteriorly Luxation requires assistance Subluxation auto-reduces The disc can be pulled or torn anteromedially by the lateral pterygoid
88
How to reduce a luxated TMJ
Stand behind patient with thumbs on occlusal surface and fingers below chin Push inferiorly with thumbs while fingers close mandible Condylar head will slide back into articular fossa
89
TMJ noises
Click: with anterior disc displacement Opening: disc clicks over anteriorly moving condyle Closing: condyle moves posteriorly past disc Crepitus: associated with osteoarthritis Dull thud: self-reducing subluxation of condyle
90
Six TMJ movements
``` Protrusion Retrusion Opening Closing Medial excursion Lateral excursion ```
91
What is the normal range of motion for TMJ opening, protrusively, and laterally ?
50mm open 10mm protrusively 10mm laterally
92
Cervical vertebrae
C1-C7 ``` C1 = atlas C2 = axis ``` Transverse foramina allow passage of vertebral artery to form basilar
93
Atlanto occipital joint
Between C1 and atlas Allows head to nod yes (flexion and extension)
94
Atlanto axial joint
Between C1 and C2 Allows head to shake no (pivot)
95
Platysma muscle
Innervated by CN VII Blends with orbicularis oris Superficial to deep cervical fascia
96
Investing layer of deep cervical fascia contains what muscles and glands?
Sternocleidomastoid, trapezius Submandibular and parotid glands
97
Pre tracheal later of deep cervical fascia contains what?
Thyroid gland Larynx Pharynx Esophagus
98
Prevertebral layer of deep cervical fascia contains what?
Vertebrae and deep cervical muscles The prevertebral layer is why the thyroid moves with laryngeal muscles ??? Maybe pretracheal
99
Contents of the carotid sheath
Common carotid artery Internal jugular vein CN X Also lymph nodes, carotid sinus nerve, sympathetic nerves
100
Retropharyngeal space
Between pharynx and prevertebral fascia Concern for infection spread because it connects with mediastinum
101
Posterior triangle of the neck
Anterior - SCM Posterior - Trapezius Inferior - clavicle Floor - splenius capita, levator scapulae, and scalene muscles Roof: skin, superficial fascia and platysma, deep investing fascia Contains cervical plexus, great auricular nerve, lesser occipital nerve, subclavian vein, artery, brachial plexus
102
Anterior triangle of the neck
``` Anterior - neck midline Posterior - SCM Inferior - inferior border of mandible Floor - pharynx, larynx, thyroid Roof - skin, superficial fascia and platysma, deep investing fascia ``` Contains infrahyoids, suprahyoids, common/internal/external carotids, internal/external jugular veins, retro mandibular vein, CN X, XI and XII
103
Submandibular triangle (part of anterior triangle)
Inferior - Digastric Superior - inferior mandible Floor - mylohyoid and hyoglossus Roof - same Contains submandibular gland, submandibular lymph nodes, hyoglossal nerve, mylohyoid nerve, lingual and facial arteries and veins
104
Muscular triangle (part of anterior triangle)
Superior border of omohyoid SCM Midline of neck Contains infrahyoid strap muscles
105
Carotid triangle (part of anterior triangle)
Superior belly of omohyoid Posterior belly of digastric SCM Contains common carotid, internal jugular vein, CNs X, XI, XII, cervical plexus
106
Sub mental triangle (part of anterior triangle)
Right and left anterior bellies of digastric Body of hyoid Contains mylohyoid muscle
107
What muscles are innervated by the ansa cervicalis?
Sternohyoid Sternothyroid Omohyoid Thyrohyoid is innervated by C1 via CN XII
108
Sternocleidomastoid muscle
O: manubrium, clavicle I: mastoid process A: flexes neck bilaterally, pulls head to shoulder and turns head to opposite side unilaterally N: CN XI
109
Trapezius muscle
O: thoracic and cervical spine, ligamentum nucha, superior nuchal line I: scapula, lateral clavicle A: extends head bilaterally, elevates shoulder and pulls chin to opposite side unilaterally N: CN XI
110
Hyoid bone
U shaped floating bone Composed of body, greater and lesser horns
111
Torticollis (head tilting to the affected side) results from injury to what muscle?
SCM
112
Ligaments attaching to hyoid
Stylohyoid | Hypoepiglottic
113
Muscles attaching to hyoid
``` Mylohyoid (CN V3) Anterior digastric (CN V3) Posterior digastric (CN VII) Stylohyoid (CN VII) Hypoglossus (CN XII) Geniohyoid (C1 via XII) Omohyoid (ansa cervicalis) Sternohyoid (ansa cervicalis) Thyrohyoid (C1 via XII) ```
114
Digastric muscle
O: anterior head on intermediate tendon, posterior head on temporal bone I: anterior head on anterior mandible, posterior head on intermediate tendon A: raises hyoid N: anterior head V3, posterior head CN VII
115
Mylohyoid muscle
O: medial mandible (mylohyoid line) I: median raphe, body of hyoid A: raises hyoid, base of tongue, FOM N: V3
116
Geniohyoid
O: genial tubercles I: body of hyoid A: raises hyoid N: C1 via CN XII
117
Stylohyoid muscle
O: stylohyoid process I: greater horn of hyoid A: raises hyoid N: CN VII
118
Omohyoid muscle
O: superior belly on intermediate tendon, inferior belly on superior scapula I: superior belly on hyoid, inferior belly On intermediate tendon A: depresses hyoid and larynx N: ansa cervicalis
119
Sternohyoid muscle
O: manubrium of sternum I: hyoid A: depress hyoid and larynx N: ansa cervicalis
120
Sternothyroid
O: manubrium of sternum I: thyroid cartilage A: depress larynx N: ansa cervicalis
121
Thyrohyoid
O: thyroid cartilage I: hyoid A: depresses hyoid and larynx N: C1 via CN XII
122
Cervical plexus
C1-C4 Cutaneous Innervation to skin of neck, shoulder, and anterior upper chest wall Motor to infrahyoid muscles and geniohyoid Phrenic nerve (C3, 4, 5) is contributed in part by ansa cervicalis Supraclavicular nerves innervated skin over shoulder Transverse cervical nerve carries sensory Innervation to anterior and lateral neck
123
Ansa cervicalis
Motor division of cervical plexus Comes from C1 and runs with CN XII Innervates infrahyoids (except thyrohyoid), geniohyoid
124
Branches of C2, C3 loop (sensory)
Lesser occipital nerve (C2): skin of neck and scalp Great auricular nerve (C2, 3): skin over parotid gland, posterior auricle, mandible to mastoid Transverse cervical nerve (C2, 3): skin of anterior triangle
125
Phrenic nerve
C3, 4, 5 Contains motor, sensory, and sympathetic nerve fibers Sole motor Innervation to diaphragm
126
External carotid artery branches
``` Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery (terminal branch) Superficial temporal branch (terminal) ```
127
What does the ECA supply?
``` Face Thyroid Salivary gland Tongue Jaws Teeth Carotid sinus (baroreceptors) Carotid body (chemoreceptors) ```

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